Abstract
BackgroundChronic refractory hypotension (IDH, intradialytic hypotension) is a rare but serious problem encountered in patients on hemodialysis. Patients with chronic hypotension are often disqualified by transplant teams from renal transplantation. This is due to the possibility of an enormous risk of ischemic complications.Case presentationWe describe a 44-year old female patient with severe refractory hypotension (mean BP 60/30 mmHg, the lowest 48/28 mmHg), which appeared after bilateral laparoscopic nephrectomy of the infected kidneys. The kidney transplantation from a deceased donor, with infusion of the two pressor amines (dopamine, dobutamine) was performed without technical complications and the blood pressure measurements were 100–120/70–80 mmHg. The immunosuppression regimen was tacrolimus (TAC) + mycophenolate mophetil (MMF) and steroids (GS). Pressor amines were discontinued on the 18th day after the transplantation. Because of delayed graft function, 4 hemodialysis treatments were performed. The patient was discharged from the hospital on the 22nd day with good function of the transplanted kidney (the concentration of serum creatinine 117 μmol/l). During one-year follow-up, the patient has been remaining stable with a very good graft function (serum creatinine 84 μmol/l) and normal blood pressure (115/70 mmHg).ConclusionsProper preparation and adequate perioperative treatment allowed for safely performing kidney transplantation in the patient with severe IDH.
Highlights
Chronic refractory hypotension (IDH, intradialytic hypotension) is a rare but serious problem encountered in patients on hemodialysis
Proper preparation and adequate perioperative treatment allowed for safely performing kidney transplantation in the patient with severe IDH
IDH may occur as a form of acute, recurrent or rarely chronic dialysis hypotension, which is associated with the occurrence of blood pressure (BP)
Summary
Dialysis hypotension (IDH, intradialytic hypotension) is a frequent complication in patients undergoing chronic hemodialysis (HD). Reduced density and a response from the beta and beta adrenergic receptors have a clinical value Another factor associated with the occurrence of IDH is an increased production of vasodilators (adrenomedullins and nitric oxide) as a result of an increased production of proinflammatory cytokines. Repeated episodes of organ hypoperfusion, the effect of IDH, are associated on the one hand with hypertrophy and myocardial fibrosis, and on the other - with an increase in the level of endotoxins, which in turn leads to an increased production of proinflammatory cytokines, oxidative stress and dysfunction of endothelial cells [2, 4] Another cause of IDH may be bilateral nephrectomy leading to removal of sympathetic stimulus from native kidneys [5].
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